Hospice Physician Audit Reviewer (Remote)
VITAS Healthcare•Miramar, FL
•Remote
About The Position
The Hospice Physician Audit Reviewer will support external government record requests by preparing chart summaries and providing expert testimony at administrative hearings. While this position is primarily remote, it involves occasional travel to provider locations for in-person trainings and to partner with program support initiatives.
Requirements
- Board eligible/certified in Hospice and Palliative Medicine, Family Medicine, Internal Medicine, or other related specialty.
- Working knowledge of the principles of palliative medicine and symptom management.
- Completion of designated application and verification of credentials and qualifications.
- Licensed to practice medicine or osteopathy in the state in which the program is operating.
Responsibilities
- Review documentation to identify content supporting patient appropriateness for hospice care, including higher levels of care billed, if applicable.
- Review clinical history, physical findings, functional status, symptoms, and pertinent changes in plans of care.
- Review certification/recertification worksheets, narratives, plans of care, and interdisciplinary team notes to ensure they support hospice benefit appropriateness.
- Provide explanations or suggest corrections for inconsistencies or omissions in documentation.
- Prepare summaries of patient demographics, admission, course of care, disposition, and eligibility statement, focusing on documentation supporting hospice eligibility and appeal information.
- Reference evidence-based guidelines or journal articles where appropriate.
- Verify the legitimacy of claim denial codes for the level of care and dates in question.
- Identify discrepancies between claim review explanations and supporting documentation.
- Address claim denial reasons with explanations and supporting documentation.
- Identify additional chart documents that establish hospice appropriateness.
- Summarize findings from the record without conflicting with daily progress notes.
- Ensure new information is supported by additional documentation accessed from the chart.
- Perform related duties as required, including any other job-related duties assigned by supervisor or management.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
